Ted Cruz for President California Delegation Application:Request for additional information

Thank you for applying to be a delegate or alternate for Ted Cruz. In order to give further consideration to your application, additional information is required.

Before completing this form, you must confirm your Congressional District using the system provided by the U.S. House of Representatives.Look up your district by Zip Code. Then, if your Zip code spans multiple districts, look up your precise residential address and determine your Congressional District number in the manner described on the page. Then, complete this form. If you fail to confirm your Congressional District your application will be automatically declined.

Some of the fields below are the same as those completed on your original application. These fields must be completed nonetheless in order to confirm your current information and to ensure all information on your application is kept in the same place for reference and processing by the campaign.

As you complete this form, additional information on what is required in each field is available by hovering your pointer over the question mark to the right of the field's name. All fields on this form are required.

Completion of this form does not constitute an offer or acceptance to serve as a delegate or alternate, and the campaign reserves the sole right to nominate, or revoke the nomination of, any individual as a delegate or alternate in the manner provided by the rules of the Republican National Committee and the California Republican Party.

* Indicates required field

Code *

This is the Delegation Code that was included in the email you received.

Congressional District Number *

Enter the number of your Congressional District as determined by the U.S. House of Representative system. Include only the number. Example: 12

Name *

First

Last

Role in the campaign *

If you have a specific role in the campaign, such as a county or district chair, or member of a coalition, include it here. Example: Los Angeles County co-chair.

Office held or occupation *

If you hold an elected office, or a party office, include it here. (Example: Orange County Supervisor) If you do not hold an elective office, then include your occupation. This information will be included in any public announcements if you are chosen as a delegate or alternate.

Voting Address *

Line 1

Line 2

City

State

Zip Code

Country

This address must precisely match where you are registered to vote.

COUNTY name *

Enter the name of the COUNTY in which you live.

Date of Birth (MM/DD/YY) *

Mobile phone number *

Email *

Transparency, participation and good governance

If chosen then elected as a delegate or alternate, I agree to: (Check all that apply) *

Travel to and participate in the delegation organizational meeting June 25 in Los Angeles.Travel to and participate in the RNC convention in Cleveland at my own expense.Vote for the designee of Ted Cruz to serve as Chairman of the California DelegationVote for Ted Cruz for President on every ballot until he is nominated or released by the CA Chairman of the Cruz campaignVote for the designees of the Cruz for President campaign to serve on all convention committeesParticipate in all meetings and conference calls for the delegation before and during the convention

Alternate? *

Will you serve as an Alternate Delegate if offered this role? Alternates participate in the convention as delegates do, with the exception of voting only when delegates are absent.

Comments *

I hereby affirm that the information provided on this form is true and correct.

Type your full name in this box *

To confirm the accuracy of your information, type your name in this box.